Particularities of metabolic syndrome in children


  • COJOCARI Svetlana IMSP Institutul de Cardiologie
  • MATRAGUNA Nelea IMSP Institutul de Cardiologie



metabolic syndrome, children, adipokines, insulin resistance


The prevalence of metabolic syndrome in children is increasing, in parallel with the growing trends in obesity rates. The different definitions of this syndrome have prevented the development of a consensus for diagnostic criteria in the pediatric population, while the pathogenesis of metabolic syndrome is not fully understood. At the same time, early screening and treatment of unique components, which contribute to the development of metabolic syndrome, have a pivotal role in reducing cardiometabolic risk. In this review, we summarize recent advances in the definition, pathophysiology, interventions for the prevention and treatment of metabolic syndrome in children.

Author Biographies

COJOCARI Svetlana, IMSP Institutul de Cardiologie

dr. în șt. med., cercet. șt., coordonator

MATRAGUNA Nelea, IMSP Institutul de Cardiologie

dr. hab. în șt. med., conf. cercet


Helen H. Wang, Dong Ki Lee, Min Liu, Piero Portincasa, David Q.H. Wang. Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome. Pediatr Gastroenterol Hepatol Nutr., 2020; 23(3):189-230

Ahrens W, Moreno LA, Mårild S, Molnár D, Siani A, De Henauw S, et al. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes (Lond), 2014;38 Suppl 2:S4-14.

Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents an IDF consensus report. Pediatr Diabetes, 2007;8:299-306.

Magge SN, Goodman E, Armstrong SC, Committee On N, Section On E, Section On O. The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor Clustering. Pediatrics, 2017,140(2):e20171603.

Mihalopoulos NL, Yap JT, Beardmore B, Holubkov R, Nanjee MN, Hoffman JM. Cold-activated brown adipose tissue is associated with less cardiometabolic dysfunction in young adults with obesity. Obesity (Silver Spring). 2020;28(5):916-923.

Lovre D, Mauvais-Jarvis F. Trends in prevalence of the metabolic syndrome. JAMA 2015;314:950.

Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA 2015;313:1973-4.

Rashmi Ranjan Das, Manaswini Mangaraj, Sandeep Kumar Panigrahi, Amit Kumar Satapathy, Samarendra Mahapatro, Partha Sarathi Ray. Metabolic Syndrome and Insulin Resistance in Schoolchildren From a Developing Country. Front Nutr. 2020; 7: 31.

Friend A, Craig L, Turner S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord., 2013;11:71-80.

Zebenay Workneh Bitew1, Ayinalem Alemu, Ermias Getaneh Ayele, Zelalem Tenaw, Anmut Alebe, Teshager Worku. Metabolic syndrome among children and adolescents in low and middle income countries: a systematic review and meta-analysis. Bitew et al. Diabetol Metab Syndr, 2020:12:93

Prateek Kumar Panda. Metabolic syndrome in children: definition, risk factors, prevention and management-a brief overview. Pediatric oncall journal, 2019,16(3):67-72.

Victoria Higgins, Khosrow Adeli. Pediatric Metabolic Syndrome: pathophysiology and laboratory assessment. EJIFCC, 2017,8;28(1):25-42

Madeira I, Bordallo MA, Rodrigues NC, Carvalho C, Gazolla F, Collett-Solberg P, et al. Leptin as a predictor of metabolic syndrome in prepubertal children. Arch Endocrinol Metab., 2017;61(1):7-13

Ochiai H, Shirasawa T, Nishimura R, Nanri H, Ohtsu T, Hoshino H, et al. Abdominal obesity and serum adiponectin complexes among population-based elementary school children in Japan: a cross-sectional study. BMC Pediatr., 2014;14:81.

Shafiee G, Ahadi Z, Qorbani M, Kelishadi R, Ziauddin H, Larijani B, et al. Association of adiponectin and metabolic syndrome in adolescents: the caspianIII study. J Diabetes Metab Disord., 2015;14:89.

Cojocari Svetlana. Biomarkerii sindromului metabolic la copiii obezi. Practica Medicală, 2014, vol. IX, nr. 2(34), 88-94

Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(Suppl 5):S213–256.

American Diabetes Association. 2. Classification and Diagnosis of Diabetes. Diabetes care, 2017;40(Suppl 1):S11–S24.

McMahan CA., Gidding SS., Viikari JS. et al. Association of Pathobiologic Determinants of Atherosclerosis in Youth risk score and 15-year change in risk score with carotid artery intima-media thickness in young adults (from the Cardiovascular Risk in Young Finns Study). The American journal of cardiology. 2007;100(7):1124–1129.

Styne DM., Arslanian SA., Connor EL. et al. Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017; 102(3):709–757.

Rajjo T., Mohammed K., Alsawas M. et al. Treatment of pediatric obesity: an umbrella systematic review. J Clin Endocrinol Metab. 2017;102(3):763–775.

Franz MJ., Boucher JL., Rutten-Ramos S., VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet 2015;115:1447-63.

Moghetti P, Bacchi E, Brangani C, Donà S, Negri C. Metabolic effects of exercise. Front Horm Res., 2016, 47:44–57.

Elena Fornari and Claudio Maffeis. Treatment of Metabolic Syndrome in Children. Frontiers in Endocrinology, 2019:10;702

Escalante Y, Saavedra JM, García-Hermoso A, Domínguez AM. Improvement of the lipid profile with exercise in obese children: a systematic review. Prev Med., 2012, 54:293–301.

Farpour-Lambert NJ., Aggoun Y., Marchand LM., Martin XE., Herrmann FR., Beghetti M. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol., 2009, 54:2396–406.

Rubin DA., Hackney AC. Inflammatory cytokines and metabolic risk factors during growth and maturation: influence of physical activity. Med Sport Sci. 2010; 55:43– 55.

Stoner L, Rowlands D, Morrison A, Credeur D, Hamlin M, Gaffney K, et al. Efficacy of exercise intervention for weight loss in overweight and obese adolescents: meta-analysis and implications. Sports Med.,2016; 46:1737–51.

Piercy KL., Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. JAMA, 2018; 320:2020–8.

Valerio G., Maffeis C., Saggese G., Ambruzzi MA., Balsamo A., Bellone S. et al. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr., 2018;44:88.

French SA., Sherwood NE., JaKa MM., Haapala JL., Ebbeling CB., Ludwig DS. Physical changes in the home environment to reduce television viewing and sugar-sweetened beverage consumption among 5to 12yearold children: a randomized pilot study. Pediatr Obes., 2016; 11:e12–5.

National Sleep Foundation. National Sleep Foundation Recommends New Sleep Durations (2016). Available online at: national-sleep-foundation-recommends-new-sleep-times (accessed October 4, 2019).

Weng SF., Redsell SA., Swift JA., Yang M., Glazebrook CP. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child., 2012; 97:1019–26.

Sherafat-Kazemzadeh R., Yanovski SZ., Yanovski JA. Pharmacotherapy for childhood obesity: present and future prospects. Int J Obes (Lond), 2013;37(1):1–15.

Mead E, Atkinson G, Richter B, et al. Drug interventions for the treatment of obesity in children and adolescents. The Cochrane database of systematic reviews. Published online 2016 Nov 29. doi: 10.1002/14651858. CD012436

Ozkan B., Bereket A., Turan S., Keskin S. Addition of orlistat to conventional treatment in adolescents with severe obesity. Eur J Pediatr., 2004; 163(12):738–741.

Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA: the journal of the American Medical Association. 2005; 293(23):2873–2883.

Yu CC, Li AM., Chan KO. et al. Orlistat improves endothelial function in obese adolescents: a randomised trial. Journal of paediatrics and child health. 2013; 49(11):969–975.

Mechanick JI., Youdim A., Jones DB., et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013; 21(Suppl 1):S1–27.

Shah AS., Jenkins T., Gao Z. et al. Lipid changes 8 years post gastric bypass in adolescents with severe obesity (FABS-5+ study). Int J Obes (Lond). 2017; 41(10):1579–1584.

Inge TH., Jenkins TM., Xanthakos SA. et al. Longterm outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. The lancet Diabetes & endocrinology. 2017;5(3):165–173.

Inge TH., Courcoulas AP., Jenkins TM. et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. N Engl J Med. 2016;374(2):113–123.

Barlow SE. Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics, 2007:120:S164–92.





Research Article